Pseudotumor cerebri syndrome causing a terson like syndrome
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A 39-year-old woman with rheumatoid arthritis, sleep apnea, and a body mass index of 55 presented with nausea, vomiting, and floaters in the right eye for two days. Two weeks prior, she developed positional headaches, blurry vision, and transient visual obscurations. On presentation, her best-corrected visual acuity was 20/25 in each eye, there was no relative afferent pupillary defect and the examination of external structures and anterior segment was unremarkable.

Funduscopic examination revealed Frisen grade 4 papilledema in the right eye with vitreous, subretinal, and intraretinal hemorrhages, and grade 3 in the left eye with flame-shaped hemorrhages. Head CT with contrast appeared normal, an MRI was not possible due to body habitus and weight restrictions. Lumbar puncture under fluoroscopic guidance revealed an opening pressure of 310 mm CSF with normal composition. Humphrey visual field 24-2 SITA Fast was reliable with an enlarged blind spot and a few central changes in the right eye (mean deviation 4.00 dB) and was essentially full with mild central depression in the left eye (mean deviation 3.55 dB).

She was started on acetazolamide 500 mg twice daily, which was titrated up to 1500 mg twice daily with gradual resolution of symptoms over a month. At two month follow up, the vitreous hemorrhage had resolved and there was a marked improvement in the papilledema bilaterally.

Source:https://www.sciencedirect.com/science/article/pii/S245199362030308X?dgcid=rss_sd_all
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